Key result
Single-ring isolation resulted in better 2-year atrial fibrillation-free survival compared with wide antral isolation (74% vs 61%; P=0.031), but did not reduce recurrence of all atrial arrhythmias.
Why the study?
Does single-ring isolation reduce the recurrence of atrial fibrillation and organized atrial tachyarrhythmias compared to wide antral isolation in patients with highly symptomatic atrial fibrillation?
RCT (n=220)
2x2 factorial
Does single-ring isolation reduce the recurrence of atrial fibrillation and organized atrial tachyarrhythmias compared to wide antral isolation in patients with highly symptomatic atrial fibrillation?
Absolute Event Rate: 74% vs 61%
p-value: p=0.031
Single-ring isolation improves long-term freedom from atrial fibrillation compared to wide antral isolation, though it does not significantly reduce the recurrence of all atrial arrhythmias.
Supports single-ring isolation to improve AF-free survival in symptomatic patients; extends randomized ablation strategy comparisons.
BACKGROUND: Electric isolation of the pulmonary veins and posterior left atrium with a single ring of radiofrequency lesions (single-ring isolation [SRI]) may result in fewer atrial fibrillation (AF) recurrences than wide antral pulmonary vein isolation (wide antral isolation [WAI]) by abolishing extravenous AF triggers. The effect of mitral isthmus line (MIL) ablation on outcomes after SRI has not previously been assessed. METHODS AND RESULTS: We randomly assigned 220 consecutive patients (58 ± 10 years old; 82% men) with highly symptomatic AF (61% paroxysmal, 39% persistent/longstanding persistent) to undergo either SRI or WAI. Half of each cohort was also randomly allocated to have left lateral MIL ablation (2 ×2 factorial study design). Patients were followed clinically and with 7-day Holter studies for arrhythmia recurrences. The primary end points were recurrence of AF and organized atrial tachyarrhythmias. AF-free survival at 2 years was better after SRI (74% [95% CI, 65%-82%]) than WAI (61% [51%-70%]; P=0.031). Organized atrial tachyarrhythmia-free survival was similar after SRI and WAI (67% [57%-75%] ersus 64% [54%-72%], respectively, at 2 years; P=0.988). MIL ablation resulted in better 2-year organized atrial tachyarrhythmia-free survival (71% [62%-79%] versus 60% [50%-69%]; P=0.07), which approached statistical significance. Survival free of any atrial arrhythmia after one procedure was not significantly affected by isolation technique or MIL ablation. Conclusions- SRI resulted in fewer AF recurrences compared with WAI on long-term follow-up but did not reduce the recurrence of all atrial arrhythmias. MIL ablation may reduce organized atrial tachyarrhythmia recurrences. Clinical Trial Registration- http://www.anzctr.org.au; ACTRN12606000467538.
No takes yet. Share an insight, caveat, or question.
Lim et al. (2012) conducted an RCT in highly symptomatic atrial fibrillation (n=220). Single-ring isolation vs. Wide antral pulmonary vein isolation was evaluated on recurrence of AF (reported as AF-free survival) (p=0.031). Single-ring isolation resulted in better 2-year atrial fibrillation-free survival compared with wide antral isolation (74% vs 61%; P=0.031), but did not reduce recurrence of all atrial arrhythmias.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: